Provider Demographics
NPI:1053973800
Name:LATTANZIO, NATALIE BENTIVEGNA (DDS)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:BENTIVEGNA
Last Name:LATTANZIO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:NATALIE
Other - Middle Name:ROSE
Other - Last Name:BENTIVEGNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3404 S DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8602
Mailing Address - Country:US
Mailing Address - Phone:813-505-2609
Mailing Address - Fax:
Practice Address - Street 1:3404 S DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8602
Practice Address - Country:US
Practice Address - Phone:813-505-2609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist